1 Interprofessional Integration & Sustainability of One Health in Education and Beyond Kaja Abbas, François Elvinger, Stephen Eubank, Jennifer Hodgson, Kathryn Hosig, Cynda Johnson, Thomas Kerkering, Leigh-Anne Krometis, Susan Marmagas, Margaret O’Dell, William Pierson, Kerry Redican, Gerhardt Schurig, Peter Vikesland, Jocelyn Widmer 3 Soil, Water, Air, Fire 4 Soil, Water, Air, Fire Plants, Worms, Arthropods, Microorganisms 5 Soil, Water, Air, Fire Plants, Worms, Arthropods, Microorganisms Us! individuals and populations Wild Animals Domestic Animals individuals and populations 6 Interfaces/Interactions? Soil, Water, Air, Fire constructs! Plants, Worms, Arthropods, Microorganisms Us! individuals and populations Wild Animals Domestic Animals individuals and populations 7 Interfaces/Interactions? Soil, Water, Air, Fire constructs! Plants, Worms, Arthropods, Microorganisms Us! individuals and populations Wild Animals Domestic Animals individuals and populations •Assessment •Intervention Benefits/Costs?8 Dynamic Stability Interfaces/Interactions? Soil, Water, Air, Fire constructs! Plants, Worms, Arthropods, Microorganisms Us! individuals and populations Wild Animals Domestic Animals individuals and populations •Assessment •Intervention Benefits/Costs?9 Dynamic Stability – One Health! Interfaces/Interactions? Soil, Water, Air, Fire constructs! Plants, Worms, Arthropods, Microorganisms Us! individuals and populations Wild Animals Domestic Animals individuals and populations •Assessment •Intervention Benefits/Costs?10 One Health One Health recognizes the dynamic interdependence of human, animal, and environmental health, and encompasses the interdisciplinary efforts of medical, veterinary, public health and environmental professionals to protect, promote, and improve health. Virginia Tech VMRCVM Population Health Group One Health – the Disciplines and Topics … Incomplete, alphabetic order (no importance rank), with overlaps and interdependencies •Agriculture (land use and sustainability) •Animal welfare •Antimicrobial resistance •Biomedical and translational research •Economics of health and disease •Environmental burden of human and animal ‘activities’ •Food quality, production, protection, safety, security } Water! •Global health •Human-animal bond (companion, service, production, entertainment and culture) •Infectious diseases (emerging) •Movement and trade •Occupational health •Outbreak investigation •Public policy and regulation •Preparedness (diagnostics, surveillance, response, mitigation, continuity of ops) •Toxins •Urban planning, built environment •Wildlife (interaction, incursion in space and time, cohabitation) •Zoonoses … and others One Health – the Disciplines and Topics … Incomplete, alphabetic order (no importance rank), with overlaps and interdependencies •Agriculture (land use and sustainability) •Animal welfare •Antimicrobial resistance •Biomedical and translational research •Economics of health and disease •Environmental burden of human and animal ‘activities’ •Food quality, production, protection, safety, security } Water! •Global health •Human-animal bond (companion, service, production, entertainment and culture) •Infectious diseases (emerging) •Movement and trade •Occupational health •Outbreak investigation •Public policy and regulation •Preparedness (diagnostics, surveillance, response, mitigation, continuity of ops) •Toxins •Urban planning, built environment •Wildlife (interaction, incursion in space and time, cohabitation) •Zoonoses … and others One Health – the Cast … The enviros – The physicians – Leigh Anne Krometis Cynda Johnson Susan Marmagas Tom Kerkering Peter Vikesland Molly O’Dell Jocelyn Widmer The others – The vets – Kaja Abbas François Elvinger Stephen Eubank Jennie Hodgson Kathy Hosig Bill Pierson Kerry Redican Gerhardt Schurig … and others! One Health One Health Systems Perspectives on Competency Based Curriculum & Interprofessional Education Health revolution of 20th century ● Life expectancy ○ 10,000 BC - 1820 ■ ~ 25 years ○ 1900 ■ ~ 31 years ○ 2000 ■ ~ 64 years ○ 2013 ■ ~ 68 years Life expectancy, income per capita, by decade Source: Preston et al, World Bank Data Knowledge to improve health Courtesy of Julio Frank Flexner report (1910) - Medicine Welch-Rose report (1915) - Public Health Goldmark report (1923) - Nursing Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World http://www.healthprofessionals21.org/ Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P, Kistnasamy B, Meleis A, Naylor D, Pablos-Mendez A, Reddy S, Scrimshaw S, Sepulveda J, Serwadda D, Zurayk H. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010 Dec 4;376(9756):1923–1958. PMID: 21112623 Roadmap for Veterinary Medical Education in the 21st Century — Responsive, Collaborative, Flexible http://www.aavmc.org/roadmap North American Veterinary Medical Association Consortium. Roadmap for Veterinary Medical Education in the 21st Century - Responsive, Collaborative, Flexible. NAVMEC Report and Recommendations. Systems framework of education & health Proposed reforms Proposed reforms Health disciplines How to diffuse knowledge across multiple disciplines? • Human medicine (& nursing) o prevention and treatment of human diseases • Veterinary medicine o prevention and treatment of animal diseases • Public health o (human & animal) disease prevention o health promotion • Engineering o technology to improve human & animal health • … & more disciplines ... Health professional Why provide interprofessional education? Enhanced knowledge to improve health ● Norm ● 21st century ○ knowledge expertise & ○ knowledge expertise & skills in a silo skills in a silo discipline discipline ○ effective team member ■ human medicine ■ communicate & ■ veterinary medicine collaborate across ■ nursing disciplines ■ public health ■ engineering ■ … & more ... Three generations of reform Competency-based education Case study ● Competency-based ● New course education ○ Modeling infectious diseases in humans & ● Interprofessional animals education ■ public health program ■ Virginia Tech ■ spring 2014 Health system needs? ● CDC ○ 2009 influenza pandemic ■ Interpret findings from modeling studies published in academic journals. ■ Develop an in-house team to develop virtual models to understand infectious disease epidemiology and economics. ● recommend implementation of effective interventions ■ Communicate to wide range of audience ● policy makers ● community ● How to provide education in modeling infectious diseases to address this health system need? ○ public health departments ■ international, national, state, local Modeling infectious diseases in humans & animals New course (Spring 2014) Competencies Curriculum 1. Critically evaluate scientific ● Journal club articles in mathematical ● Systematic review modeling of infectious diseases. 2. Develop computer models to ● Labs simulate infectious disease ● Project epidemics and prevention interventions. ● Report & presentation 3. Communicate scientific ● Systematic review & project findings effectively to interdisciplinary audience. Modeling infectious diseases in humans & animals Team taught course ● Faculty ● Students (9) ○ 7 faculty members ○ public health graduate ● Research focus level ○ modeling infectious diseases ● Backgrounds ● Formal training ○ biology ○ computer science ○ biochemistry ○ ecology, virology, pathology ○ engineering ○ epidemiology ○ (human medicine) ○ genetics, bioinformatics & ○ veterinary medicine computational biology ○ wildlife science ○ human medicine (guest speaker) ○ physics ○ public health ● Semester course ○ mathematics ○ 3 credits ○ mechanical engineering ○ veterinary medicine Key messages ● Competency-based ● Interprofessional education education ○ One Health: Health ○ Education of health professionals responsibly use professionals has to adapt their knowledge in to the evolving needs of the collaboration with other health system. professionals to advance health and welfare of humans, animals, communities, and environment locally and globally. One Health in education … at Virginia Tech The Master of Public Health Degree in the Virginia-Maryland College of Veterinary Medicine The Program – Facts and Numbers • Program and department started Fall 2010 • by December 2013 • 51 MPH graduates • of which 12 DVM/MPH • 2 physicians • currently 98 students in MPH degree • of which 18 DVM/MPH • Currently ~14 faculty … • Student mid career “types” – anthropologist, community services coordinator, ESL teacher, fitness coordinator, food safety expert, geographer, Health Department epidemiologist, health educator, laboratory technician / specialist / facilities manager, medical facilities coordinator, medical technologist, osteopathic school faculty member, patient navigator, physician, Public School nutritionist, registered dietician, Rescue Squad volunteer, veterinarian, wellness coordinator, … Virginia Tech’s CEPH accredited Public Health and MPH program in the Veterinary College • Mission The mission of the public health program is to protect, improve, and promote population health in Southwest and Southside Virginia, the Commonwealth, Central Appalachia, the Nation and the world by training future public health leaders through learning, discovery, and engagement in public health • Goal for Learning The program grounded in a One Health model at the human-animal- environmental health interface will